Perennially listed in The Best Lawyers in America and selected as a Pennsylvania “Super Lawyer" by his peers, Mark is a recipient of Martindale-Hubbell’s highest rating. He has written and lectured widely for the American Health Lawyers Association, Pennsylvania Bar Association, and other organizations on Medicare and Medicaid reimbursement, state/federal regulations under the Medicaid program, Medicaid managed care and compliance with health care fraud and abuse laws and services as a co-chair of AHLA’s annual Medicare and Medicaid Reimbursement Institute. He also is the author of the Medicaid Reimbursement section of the American Health Lawyers Association (Clark, Boardman, Callaghan) Health Law Practice Guide and speaks regularly at AHLA and Pennsylvania Bar Institute programs on governmental and third-party payer health care reimbursement and fraud issues and serves as a planning committee member and co-chair for AHLA’s Annual Medicare and Medicaid Reimbursement Institute in Baltimore.
Mark has served as counsel of record in litigation and other matters for health care systems, hospitals, pharmacy chains, durable medical equipment manufacturers and suppliers, long term care providers, and for national and state trade associations. Mark’s representative matters for health care industry clients have included:
• Litigation resulting in the invalidation of CMS reaudit rule that prevented teaching hospitals from adding misclassified teaching costs to their base-year Average Per Resident Amounts.
• Defense of False Claim Act investigations and qui tam suits, including settlement of a Medicare “outlier” fraud case with no corporate integrity agreement.
• Rulemaking comments on behalf of national trade association contesting CMS’ proposal to eliminate Medicaid funding for graduate medical education costs.
• Formulation and legal audits of provider taxes and intergovernmental transfers (IGTs) on behalf of hospital, trade association and governmental clients.
• Suits and high stakes arbitrations against private third-party payers and Medicaid managed care plans (involving down-codes, disallowances, breach of contract claims, and out-of-network reimbursements).
• Negotiations and restructuring of third-party payer contracts.
• Successful suits against various States challenging reductions to Medicaid reimbursement, including budget-driven Medicaid cuts, and rate discrimination against out-of-state providers.
• Litigation resulting in the Third Circuit University Medical Center rule (prohibiting Medicare recoupments against health care providers operating in bankruptcy reorganization).
• Part A reimbursement hearings before the Provider Reimbursement Review Board, including a PRRB decision striking CMS’ requirement for filing duplicate claims forms with Part A intermediaries as a condition of receiving medical education supplements for Medicare managed care enrollees.
Mark earned his undergraduate degree from Rutgers University-New Brunswick in 1972 and his law degree from Georgetown University Law Center in 1975.